Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-0856, Japan.
Surg Endosc. 2010 Apr;24(4):834-40. doi: 10.1007/s00464-009-0673-2.
Endoscopic stent therapy is routinely used to treat postoperative bile duct strictures. However, no studies have detailed long-term follow-up evaluation for more than 10 years.
This study enrolled 22 consecutive patients with a diagnosis of postoperative bile duct strictures from 1987 to 2006. Cases involving digestive tract reconstruction were excluded. Dilation was performed after passage of a guidewire through the stricture followed by temporary stent placement. The final objective was to achieve stent free status after sufficient dilation. The stent was removed when the cholangiogram showed apparent resolution of the stricture. If stent removal was not possible within 12 months, the authors proposed a surgical treatment option.
Initial therapy was performed for 21 patients (21/ 22, 95%). The remaining patient had complete occlusion, which required surgical repair. For 3 of the 21 cases, guidewire passage through the narrow stricture under fluorographic guidance alone was impossible. However, visualization by peroral cholangioscope enabled passage of the guidewire in all three cases. In two cases, the stricture persisted longer than 12 months, rendering stent removal impossible. Therefore, stent removal within 12 months was achieved in 90% of the cases (19/21). Two patients requested prolonged stenting in lieu of the authors' proposal to repeat the surgery. This resulted in sufficient dilation after an additional 6 months. Consequently, a total of 21 patients were enrolled for long-term follow-up evaluation. The posttreatment follow-up period was 121 + or - 64 months (range, 31-254 months; median, 120 months). Three patients died of causes unrelated to hepatobiliary disease. The remaining patients were successfully followed up until this writing. The overall long-term success rate was 95% (20/21). No hepatobiliary malignancies developed within the follow-up period.
Endoscopic stent therapy is available for postoperative bile duct strictures. Long-term prognosis for more than 10 years is excellent. Repeat surgical interventions may be unavoidable in some cases, but endoscopic treatment should be proposed as the first-line treatment.
内镜下支架治疗通常用于治疗术后胆管狭窄。然而，尚无研究详细评估 10 年以上的长期随访结果。
本研究纳入了 1987 年至 2006 年期间诊断为术后胆管狭窄的 22 例连续患者。排除了涉及消化道重建的病例。导丝通过狭窄部位后进行扩张，然后临时放置支架。最终目标是在充分扩张后实现无支架状态。当胆管造影显示狭窄明显缓解时，取出支架。如果 12 个月内无法取出支架，则作者建议选择手术治疗方案。
对 21 例患者（21/22，95%）进行了初始治疗。其余患者存在完全闭塞，需要手术修复。在 21 例患者中有 3 例，仅在透视引导下导丝无法通过狭窄的胆管。但是，经口胆管镜检查可使 3 例患者的导丝通过。在 2 例患者中，狭窄持续时间超过 12 个月，导致支架无法取出。因此，90%（19/21）的病例在 12 个月内成功取出支架。2 例患者要求延长支架置入，而非作者建议的重复手术。因此，在另外 6 个月后充分扩张。最终，共 21 例患者纳入长期随访评估。治疗后随访时间为 121±64 个月（范围，31-254 个月；中位数，120 个月）。3 例患者因与肝胆疾病无关的原因死亡。其余患者在此期间均成功随访。总体长期成功率为 95%（20/21）。随访期间未发生肝胆恶性肿瘤。
内镜下支架治疗可用于术后胆管狭窄。10 年以上的长期预后良好。在某些情况下可能需要重复手术干预，但应将内镜治疗作为一线治疗方案。
